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Segmental and global lordosis changes with two-level axial lumbar interbody fusion and posterior instrumentation.

Melgar MA, Tobler WD, Ernst RJ, Raley TJ, Anand N, Miller LE, Nasca RJ - Int J Spine Surg (2014)

Bottom Line: Mean back pain severity improved from 7.8±1.7 at baseline to 3.3±2.6 at 2 years (p < 0.001).Mean ODI scores improved from 60±15% at baseline to 34±27% at 2 years (p < 0.001).Patients with loss or gain in segmental or global lordosis experienced similar 2-year outcomes versus those with less than a 5° change.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Memorial Hospital, Gulfport, MS.

ABSTRACT

Background: Loss of lumbar lordosis has been reported after lumbar interbody fusion surgery and may portend poor clinical and radiographic outcome. The objective of this research was to measure changes in segmental and global lumbar lordosis in patients treated with presacral axial L4-S1 interbody fusion and posterior instrumentation and to determine if these changes influenced patient outcomes.

Methods: We performed a retrospective, multi-center review of prospectively collected data in 58 consecutive patients with disabling lumbar pain and radiculopathy unresponsive to nonsurgical treatment who underwent L4-S1 interbody fusion with the AxiaLIF two-level system (Baxano Surgical, Raleigh NC). Main outcomes included back pain severity, Oswestry Disability Index (ODI), Odom's outcome criteria, and fusion status using flexion and extension radiographs and computed tomography scans. Segmental (L4-S1) and global (L1-S1) lumbar lordosis measurements were made using standing lateral radiographs. All patients were followed for at least 24 months (mean: 29 months, range 24-56 months).

Results: There was no bowel injury, vascular injury, deep infection, neurologic complication or implant failure. Mean back pain severity improved from 7.8±1.7 at baseline to 3.3±2.6 at 2 years (p < 0.001). Mean ODI scores improved from 60±15% at baseline to 34±27% at 2 years (p < 0.001). At final follow-up, 83% of patients were rated as good or excellent using Odom's criteria. Interbody fusion was observed in 111 (96%) of 116 treated interspaces. Maintenance of lordosis, defined as a change in Cobb angle ≤ 5°, was identified in 84% of patients at L4-S1 and 81% of patients at L1-S1. Patients with loss or gain in segmental or global lordosis experienced similar 2-year outcomes versus those with less than a 5° change.

Conclusions/clinical relevance: Two-level axial interbody fusion supplemented with posterior fixation does not alter segmental or global lordosis in most patients. Patients with postoperative change in lordosis greater than 5° have similarly favorable long-term clinical outcomes and fusion rates compared to patients with less than 5° lordosis change.

No MeSH data available.


Related in: MedlinePlus

Scatterplot demonstrating relationship between preoperative lordosis and postoperative lordosis change at L1-S1. The grey shaded area represents ±5° compared to pre-treatment values. Patients with lordosis change > 5° are represented in red.
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Figure 0001: Scatterplot demonstrating relationship between preoperative lordosis and postoperative lordosis change at L1-S1. The grey shaded area represents ±5° compared to pre-treatment values. Patients with lordosis change > 5° are represented in red.

Mentions: Mean global lordosis was unchanged and mean segmental lordosis decreased 1°. The magnitude of change in global lordosis 2 years after surgery was moderately inversely correlated with preoperative L1-S1 lordosis (r = -0.44, p < 0.001) (Figure 1). A weak inverse correlation (r = -0.33, p = 0.01) was also observed in preoperative segmental lordosis and postoperative change in segmental lordosis (Figure 2). Maintenance of lordosis, defined as a change in Cobb angle ≤ 5°, was identified in 84% of patients at L4-S1 and 81% of patients at L1-S1 (Figure 3, Figure 4). Patients with loss or gain in segmental or global lordosis experienced similar 2-year outcomes versus those with less than a 5° change (Table 2).


Segmental and global lordosis changes with two-level axial lumbar interbody fusion and posterior instrumentation.

Melgar MA, Tobler WD, Ernst RJ, Raley TJ, Anand N, Miller LE, Nasca RJ - Int J Spine Surg (2014)

Scatterplot demonstrating relationship between preoperative lordosis and postoperative lordosis change at L1-S1. The grey shaded area represents ±5° compared to pre-treatment values. Patients with lordosis change > 5° are represented in red.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4325488&req=5

Figure 0001: Scatterplot demonstrating relationship between preoperative lordosis and postoperative lordosis change at L1-S1. The grey shaded area represents ±5° compared to pre-treatment values. Patients with lordosis change > 5° are represented in red.
Mentions: Mean global lordosis was unchanged and mean segmental lordosis decreased 1°. The magnitude of change in global lordosis 2 years after surgery was moderately inversely correlated with preoperative L1-S1 lordosis (r = -0.44, p < 0.001) (Figure 1). A weak inverse correlation (r = -0.33, p = 0.01) was also observed in preoperative segmental lordosis and postoperative change in segmental lordosis (Figure 2). Maintenance of lordosis, defined as a change in Cobb angle ≤ 5°, was identified in 84% of patients at L4-S1 and 81% of patients at L1-S1 (Figure 3, Figure 4). Patients with loss or gain in segmental or global lordosis experienced similar 2-year outcomes versus those with less than a 5° change (Table 2).

Bottom Line: Mean back pain severity improved from 7.8±1.7 at baseline to 3.3±2.6 at 2 years (p < 0.001).Mean ODI scores improved from 60±15% at baseline to 34±27% at 2 years (p < 0.001).Patients with loss or gain in segmental or global lordosis experienced similar 2-year outcomes versus those with less than a 5° change.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, Memorial Hospital, Gulfport, MS.

ABSTRACT

Background: Loss of lumbar lordosis has been reported after lumbar interbody fusion surgery and may portend poor clinical and radiographic outcome. The objective of this research was to measure changes in segmental and global lumbar lordosis in patients treated with presacral axial L4-S1 interbody fusion and posterior instrumentation and to determine if these changes influenced patient outcomes.

Methods: We performed a retrospective, multi-center review of prospectively collected data in 58 consecutive patients with disabling lumbar pain and radiculopathy unresponsive to nonsurgical treatment who underwent L4-S1 interbody fusion with the AxiaLIF two-level system (Baxano Surgical, Raleigh NC). Main outcomes included back pain severity, Oswestry Disability Index (ODI), Odom's outcome criteria, and fusion status using flexion and extension radiographs and computed tomography scans. Segmental (L4-S1) and global (L1-S1) lumbar lordosis measurements were made using standing lateral radiographs. All patients were followed for at least 24 months (mean: 29 months, range 24-56 months).

Results: There was no bowel injury, vascular injury, deep infection, neurologic complication or implant failure. Mean back pain severity improved from 7.8±1.7 at baseline to 3.3±2.6 at 2 years (p < 0.001). Mean ODI scores improved from 60±15% at baseline to 34±27% at 2 years (p < 0.001). At final follow-up, 83% of patients were rated as good or excellent using Odom's criteria. Interbody fusion was observed in 111 (96%) of 116 treated interspaces. Maintenance of lordosis, defined as a change in Cobb angle ≤ 5°, was identified in 84% of patients at L4-S1 and 81% of patients at L1-S1. Patients with loss or gain in segmental or global lordosis experienced similar 2-year outcomes versus those with less than a 5° change.

Conclusions/clinical relevance: Two-level axial interbody fusion supplemented with posterior fixation does not alter segmental or global lordosis in most patients. Patients with postoperative change in lordosis greater than 5° have similarly favorable long-term clinical outcomes and fusion rates compared to patients with less than 5° lordosis change.

No MeSH data available.


Related in: MedlinePlus